*Amgen Inc., Thousand Oaks, CA, USA; †ZS Pharma, Redwood City, CA, USA; ‡Daiichi Sankyo, Inc., Parsippany, NJ, USA; §Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
Background: This study aimed to build upon research from 2011 and 2012 to assess trends in preferences, satisfaction, and functionality of tablet computers in addition to applications (apps) used among Field Medical Personnel. Methods: A web-based, anonymous survey was disseminated to United States Field Medical Personnel. Findings were compared to 2011 and 2012 results to assess trends. Results: A total of 113 respondents who self-identified as Field Medical Personnel completed the survey. Overall, 93% of respondents reported utilizing a tablet for work, an increase of 4% from 2012 and 48% from 2011. Compared with prior years, tablets are being increasingly utilized for nearly all unique functionalities. The most common apps reported for different functions include Concur for expense reporting (72%) and travel management (52%); WebEx® for tele/video conferencing (60%); iBooks® for presentation of clinical trial information (16%); Microsoft PowerPoint® for presentation of slides (19%); PubMed for performing literature search (22%); and Web Browser, Salesforce®, and Veeva® for documenting key opinion leader interactions (12% each). While Field Medical Personnel are using tablets for expanded functionalities, 50% of respondents would like to retain use of their laptops in the field, 33% prefer to eventually only use tablets, and 17% remain undecided. These preferences were consistent with 2012 data (46%, 32%, and 21%, respectively). Conclusions: This study provides evidence that tablets have become more ubiquitous in their usage by Field Medical Personnel since the original 2011 investigations and continued monitoring of technology trends is important to ensure that field medical departments remain current and effective in today’s competitive pharmaceutical environment.
Keywords [5-6 words]
iPads®, tablets, MSL, Medical Science Liaisons, Field Medical Affairs, trends
Tablet Computer Utilization and Satisfaction among Field Medical Personnel: Trends from 2011-2014
About five years after the launch of the iPad® in 2010, tablet computers (tablets) have become an essential tool utilized within several business sectors.1 One such sector, the pharmaceutical industry, has increasingly adopted tablets to facilitate medical affairs team personnel activities, especially those of Medical Science Liaisons (MSLs). MSLs practice as field-based scientific experts employed to develop and maintain professional relationships between pharmaceutical companies and healthcare providers (HCPs) through the provision of medical and scientific information regarding the company’s products and related therapeutic areas. For MSLs, tablets have proven useful for many functions in their daily practice. To enhance thought leader engagement, MSLs utilize the tablet to readily retrieve information, such as slide presentations and interactive demonstrations. MSLs can also utilize the tablet to assist with their various administrative functions while traveling, including travel management, expense reporting, and documenting thought leader interactions.
With this advancement in technology, research on the adoption and utility of tablet was assessed in a study conducted by Monera et al. in 2011, one year after the launch of the iPad®. At the time of the study, 45% of MSLs who completed the survey reported using a tablet in the field.2 One year later, in a study conducted by Haile-Meskale et al., the utilization of tablets among MSLs was again explored and demonstrated dramatic expansion of tablet usage, with a near doubling to 89%.3 Given this widespread increase in a one-year timeframe, it is of special importance to continue research in this area to further define trends related to the growing adoption of this technology. Therefore, a third survey was conducted to capture preferences, satisfaction, and functionality of tablets among field medical personnel in the present day and to further compare these findings to previous research results.
From July 7, 2014 to October 1, 2014, a web-based, anonymous survey consisting of up to 32 questions was disseminated to US field medical personnel representative of various pharmaceutical and biopharmaceutical companies (see Supplementary Data Table S1 for survey questions). The study protocol was approved by the Rutgers University Institutional Review Board and informed consent was obtained from each survey respondent. Field medical personnel, in this study, were comprised of MSLs, MSL supervisors, and health outcomes liaisons (field experts in health economics and outcomes who liaise between payer customers and pharmaceutical companies), hereafter referred to collectively as MSLs. Survey questions were designed to assess preferences, satisfaction, and functionality of tablets in addition to tablet applications (apps). MSLs were identified through a variety of mediums, including the Rutgers Pharmaceutical Industry Fellowship alumni database; individual field medical directors who disseminated the survey to their respective MSL teams; members of the MSL Society; and through the MSL LinkedIn groups MSL World and The Medical Affairs Company. Personal identifiable factors (e.g., name, company, and contact information) remained anonymous and respondents were able to discontinue the survey at any time. MSLs that discontinued the survey prior to completion had their partial responses included in the analysis. For this reason n value variances between questions are due to these partial responses. Results of this survey (representing 2014 data) were compared to findings from research conducted in 2011 and 2012 to define trends in the evolving integration of tablets by MSLs in the present day.
One hundred and fifty-one (151) MSLs within the pharmaceutical industry from across the United States (US) responded to this survey. One hundred and thirteen (113) MSLs continued on past the first question. This was an increased response value compared to previous years, as 88 MSLs responded to the 2012 survey and 77 MSLs responded to the 2011 survey.
Educational background and tenure as an MSL are outlined in Figure 1 and Figure 2, respectively. The respondents worked for companies of various sizes, as presented in Table 1. The MSLs who responded to the survey were fairly evenly distributed across the US; with about 33% covering the Northeast, 35% covering the Southeast, 26% covering the Southwest, 31% covering the Midwest, and 33% covering the West Coast (see Supplementary Data Figure S1 for territory delineations).
Figure 1: Educational Background
Figure 2: Years of Field Experience
Overall, 105 out of 113 (93%) of the MSLs reported that the Field Medical Department at their company uses tablets. Figure 3 shows tablet use throughout the previous years. Eleven percent (11%) reported using a tablet for less than 6 months, 6% for 6-12 months, 28% for 1-2 years and 49% for over 2 years. Of the MSLs who use a tablet, all reported using an iPad®.
Figure 3: Use a Tablet for Work
Among the respondents using tablets, the business and scientific functions of the tablet were analyzed and compared to prior years (Figure 4). The top six uses for tablets by the MSLs surveyed in 2014 are as follows: presenting slides (96%), travel management (85%), presenting clinical trial results through publications (83%), navigating and documenting a scientific conference (82%), conducting literature searches (81%), and documenting key opinion leader (KOL) interactions (81%).
Figure 4: MSL Tablet Uses
MSLs rated their satisfaction with the use of a tablet for various business and scientific functionalities using a 5-point Likert scale, with 1 representing very dissatisfied and 5 representing very satisfied (Figure 5). The functions with the highest percentage of MSLs reporting very satisfied or satisfied are as follows: presenting clinical trial results through publications (77%), accessing FAQs and medical response documents (75%), travel management (73%), presenting slides (72%), and expense reporting (72%). The satisfaction levels reported in 2014 were largely consistent with those reported in previous years (Figure 6)
Figure 5: Satisfaction with Tablet Functionalities
Figure 6: Satisfaction with Tablet Functionalities in 2012
Device preference was analyzed for each function among MSLs who use tablets. The tablet was preferred over the laptop for the following five functionalities: navigating/documenting scientific conferences, presenting clinical trial results through publications, presenting slides, interactive demonstrations, and capturing an electronic signature for unsolicited requests (Figure 7). Despite the noted preference among responders, there were a large number of MSLs reported interactive demonstrations and capture of an electronic signature for unsolicited requests functionalities were not applicable to their jobs (32% and 37%, respectively). The results regarding device preference are consistent with preferences reported in previous years (Figure 8).
Figure 7: Device Preference
Figure 8: Device Preference in 2012
Device preference varied based on whether or not the device was being used in the field. When in the field, 45% of survey respondents (n=35) use their tablet more than their laptop, while only 23% (n=18) use their laptop more than their tablet, 19% (n=15) use both technologies equally, and 12% (n=9) do not use their laptop at all. Conversely, when not in the field, all respondents (n=78) reported using a laptop to some extent, and 67% (n=52) are using a laptop more than a tablet. Half of respondents (n=39) do not want to switch someday to a tablet-only approach, while 33% (n=26) reported they would switch, and 17% (n=13) are undecided.
Limitations of Using a Tablet
Key limitations of using a tablet reported by MSLs include connection availability to internet and/or intranet, lack of compatibility with Microsoft®-based applications (Word, Excel, PowerPoint, etc.), lack of keyboard, optional external keyboard being too small, small screen size, difficulty multitasking, and limited available apps.
Survey respondents reported which apps they used for each functionality (Table 2). This was an open-ended question in the survey, allowing respondents to report multiple apps for the same function. The MSLs reported 21 unique apps for presenting slides, with Microsoft PowerPoint® being mentioned most frequently (14 instances). This is a change from 2012, where Keynote® was the most frequently reported app for presenting slides (Table 3). Company-developed apps were most frequently reported for several of the functions, including capturing electronic signatures for unsolicited requests and interactive demonstrations. Company-developed apps were most reported for navigating and documenting scientific conferences, which is a change from 2012, where Evernote® was most reported (see Supplementary Data Table S2 for full listing of app-related responses).
When asked about the biggest challenge with specific apps, respondents reported issues with apps hanging, crashing, or timing out. MSLs also mentioned that Dropbox®, GoodReader®, and Box® may not display PowerPoint slides correctly. SlideShark® seems to remedy this issue but respondents mentioned that it has a cumbersome uploading process, and it does not allow for editing capabilities. The Microsoft® Office Suite of apps has been recommended by some respondents to display and edit Microsoft® documents (including PowerPoint slides), though respondents reported a long loading time. While the Concur® app was the most popular choice for travel and expenses, respondents reported a sluggish experience. Finally, there were some respondents who reported incompatibility with the iOS calendar and MS Outlook®, which caused some meetings to be altered or even deleted. Despite these challenges, it must be acknowledged that they are based on reports from specific versions of the apps at the time of survey, which may not be representative of future and updated versions.
Content can be specifically created for use on a tablet or converted from its original format to a format suitable for a tablet. For example, since all MSLs reported currently using an iPad®, some companies may need to implement a solution for converting Microsoft PowerPoint® slides to a format that is more compatible and displays better on the Apple operating system. In some cases, companies opt to recreate slides and content as a stand-alone app. In 2014, 72% of MSLs reported that their company develops content by converting it to a format that is suitable for tablets, while 14% stated that their company develops content specifically designed for the tablet.
The type of training provided to the MSLs on how to use the tablets varied. No training was provided for 26% (n=27) of the total respondents. Of the other 74% (n=77), several MSLs reported receiving either a live or virtual training session, often with the Information Technology (IT) group, while others reported receiving both live and online training sessions. For some, the online virtual training was one single session, whereas for others, it consisted of an ongoing program with multiple modules. Some MSLs also reported receiving written instructions, either to supplement the live and virtual training sessions or, occasionally, as a substitute to a live or virtual training session. One MSL reported that beyond receiving the initial training, their team has two “tech champs” who answer questions on an ongoing basis and that their MSL trainer is available to assist with challenging problems and act as a liaison with IT. The content of the training sessions also differed. Some MSLs reported receiving training on just how to use the apps, often specifically the company-developed apps, while others received basic general device training, including a review of its functionality and battery saving tips. Overall, 64% (n=67) reported that the tablet training they received was adequate, and 10% (n=10) reported that it was inadequate.
For those that reported that they received no training or that their training was inadequate, when asked what type of training they would have wanted, they provided conflicting responses. Some stated that no training was needed, while others were split between preferring additional basic training on iPad® capabilities, more hands-on training, more app-specific training, or a more thorough demonstration of both all capabilities and how to use each app.
The survey respondents (N=78) were fairly split on how they captured unsolicited requests using their tablet, with 44% reporting they do not use their tablets at all to document or respond to unsolicited requests, while 42% reported using their tablet to capture information requested from the KOL. About one-third (35%) reported using a stylus pen or finger to capture KOL signatures, and another third (36%) sent the request directly from their tablet to the medical information department for fulfillment.
The survey respondents (N=78) were also somewhat split on whether their company required them to capture signatures for unsolicited request. About half (53%) are required to capture signatures: 17% need to do so for both on- and off label requests, while 36% reported needing to capture signatures just for off-label requests. Forty-seven percent (47%) reported that they are not required to capture signatures at all, which is lower than 2012, where 61% of the MSLs reported not needing to capture signatures.
MSLs Who Do Not Have Tablets
Out of the 113 MSLs surveyed, only 7 reported that the Field Medical Department at their company does not use tablets. When asked why their company had not adopted tablets, most reported cost saving. Only four out of seven respondents completed the remaining questions. Half of those four respondents agreed or strongly agreed that not having a tablet is a disadvantage, while the other half were neutral. The survey respondents explained they believed it was a disadvantage because a tablet provides easy access to data, allows one to be more interactive, and would streamline many actions. The lack of any disagreement differs from results from previous surveys; in 2012, 20% disagreed or strongly disagreed, and in 2011, 18% disagreed or strongly disagreed (Figure 9). When asked which scientific and business functions they would use their tablet for if they had one, all of the functions were selected by at least one respondent, with all agreeing they would use it for documenting KOL interactions, travel management, and expense reports.
Figure 9: Not Having a Tablet is a Disadvantage
In 2014, 93% of respondents reported that their field medical department uses tablets, which compares similarly to 89% in 2012 while demonstrating a drastic increase from the 45% in 2011. This steep initial increase from 2011 to 2012 indicated the rapid uptake of tablets that ultimately later plateaued in 2014 as tablets reached essential complete market penetration. Almost half of all respondent companies have been utilizing tablets for over 2 years, and all respondents reported specifically using the iPad®. In previous years, however, one respondent reported using a Google™ Nexus as their tablet of choice.
For training, the majority of respondents stated that the tablet training they received was adequate, but 10% of respondents did not consider their training adequate, and 26% did not receive any training. There were several reports stating that they received specific training on company-developed apps, and it seemed that the amount and type of training depended on how much companies utilize certain or company-specific apps. While most respondents mentioned adequate training, there does not seem to be standard level of training between companies. There also appears to be a disparity regarding the amount of training desired, since respondents may have varying degrees of familiarity with tablets and technology. Due to these discrepancies, it seems practical that companies provide training to individual MSLs on a case-by-case basis, tailored to their knowledge level.
Between 2012 and 2014, there was a > 5% increase in satisfaction with the use of tablets to access FAQs/medical response documents, for travel management and expense reporting, as well as for capturing electronic signatures for unsolicited requests. There was a corresponding > 5% decrease in satisfaction with the use of tablets to document KOL interactions and navigate conferences. This may be due to companies developing their own apps to navigate conferences, burdening MSLs with multiple systems (i.e., a company-developed conference app and an official conference app). Satisfaction with all the remaining tablet functionalities remained fairly consistent from 2012 to 2014.
When the MSLs are in the field, the majority of them report using their tablets more than their laptop; whereas when they are not in the field, the majority of respondents reported using their laptop more than their tablets. The preference for tablets in the field may be due to the nature of functions typical to the field (e.g., presenting slides or clinical trial publications), where a lightweight and portable technology platform with a simple interface is valued. This preference also relates to the satisfaction reported for those tablet functionalities typically conducted in the field, as tablet satisfaction was relatively high. The preference for laptops when conducting more administrative and/or research-based functions (e.g., documenting KOL interactions, literature searches, or tracking/identifying clinical trial sites) seems to correlates to the lower level of satisfaction with those functions on the tablet (Figure X). Some administrative tasks, such as travel management and expense reports, were reported to have a high level of satisfaction on the iPad®, perhaps due to the ease of use of the most commonly referenced app for this function, Concur®. However, respondents still prefer using the laptop for these tasks.
Overall, 50% of respondents do not want to switch to only using a tablet, while one-third do. This is consistent with the results from the 2012 survey and seems to define where field medical personnel are finding iPads® useful and not useful. In the 2011 survey, MSLs reported battery life, access to VPN, full capability with most websites, and ease of printing as limitations to using the tablet. The 2014 survey, however, did not report these limitations, as the market has responded to address some of these challenges. Over time, there have been increases in the battery life, VPN and mobile-friendly websites have become widely available, and there is improved compatibility with programs like Microsoft Office® (Office 365). Also, third-party Bluetooth keyboards are addressing the consistently reported limitation of a lack of keyboard. Nonetheless, until most of the challenges with using the tablet are addressed through advances in technology, or the level of comfort with these challenges adapts, the laptop will remain an essential device for MSLs.
Developers continually create apps to meet the demands of the tablet user, and MSLs have numerous options when selecting an app for a particular functionality. Some companies, however, place restrictions on the type of apps approved for download and/or reimbursement, which may limit the options available for MSLs. Of the apps reported by respondents, there are some functions with a well-established consensus app, some with several options available, and others that need the customization of a company-developed app.
Functionalities such as travel, expenses, navigating conferences, documenting interactions, and tele/video conferencing all have a majority consensus app. Concur® is the decisive app for both travel and expenses, possibly due to convenience of the app and/or the predominance of Concur® usage within corporations. At scientific conferences, most respondents report using conference-developed apps for both navigation and scheduling. An increasing number of conferences are now creating their own specific apps for attendees to download, so scientific communication departments may be able to reduce efforts in creating conference media for their attending employees. In documenting KOL interactions, most teams are using Veeva® (AKA iRep® or Salesforce.com®) or a company-specific app, although the customizable Veeva® seems to be the consensus tool for field medical affairs teams. Finally, the majority share of tele/video conferencing services belong to WebEx.
Several functionalities, such as displaying slide decks and publications, have several options for MSLs to choose, as each app provides certain strengths and weaknesses. To display slide decks, the PowerPoint app from the Microsoft Suite® is the most popular, while other options include Keynote®, SlideShark®, and GoodReader®. To share publications with KOLs, many MSLs lean toward the PDF apps iBooks®, PDF Expert®, Adobe®, and GoodReader® to display these documents. The decision to use one of these apps over another seems to be based on MSL preference. Since the PowerPoint is Microsoft-developed, it ensures compatibility between PowerPoint decks, something with which many of the other apps seem to struggle. However, this PowerPoint app provides read-only access unless the user has a subscription to edit the documents.
In some cases, such as interactive demonstrations and accessing FAQ and Medical Letters, apps available through the tablet may not suffice, so companies have responded by creating their own company-specific apps. While most MSLs do not use tablets for interactive demonstrations, those that do are using company-specific apps, indicating that home-grown or vendor-created apps are required to customize the content. To access FAQ and Medical Letters, most respondents are using company-specific apps or secure websites, probably because the documents contain proprietary information. The majority of respondents do not use tablets to access policies and procedures, but if they do, it is through a company app. Perhaps this could also be due to the sensitive nature of the documents.
While apps in general can provide an easy and intuitive user interface for most functions, sometimes a simple browser will suffice. This seems to be the case for literature searches, identifying clinical trial sites, and researching KOL profiles, as the majority of MSLs prefer to use the Apple iOS Safari or alternative web browsers for these tasks.
Although there appear to be a number of app options available for various functionalities, survey respondents still listed a variety of issues they face with the apps they are using. There seems to remain an opportunity for app developers, including IT departments within pharmaceutical/biotechnology companies, to improve capabilities specific to MSL scientific and business functions.
There were several limitations inherent in the study design. The first is the inability to guarantee equal representation of MSLs across companies due to the anonymity of the survey. This concern may be compounded by the dissemination provided by field directors to their respective teams, and over-representation of companies with large Rutgers Pharmaceutical Industry Fellowship alumni representation. Second is that some respondents did not complete the survey, with unequal responses for each question. Third, there are differences in individual survey respondents in each yearly survey, potentially making differences in preferences drawn across survey years not due to changes in attitude regarding tablets, but instead implicit in the uniqueness of each survey respondent. Fourth, due to the limited sample size, definite conclusions cannot be drawn from the data, nor can they be generalized to all pharmaceutical and biotechnology companies. Finally, the survey may be biased toward technology users as respondents were reached via technological means (e-mail, MSL websites, etc.).
This study provides evidence that tablets have achieved almost complete adoption by MSLs since the original 2011 analyses completed by Monera, et al. In addition to increased utilization across individuals, the functionality and variety of uses is increasing. Given these findings, continued monitoring of technology trends, specifically unique apps used, among MSLs is warranted. Awareness of the rapid and ever-changing landscape is important in ensuring that field medical departments remain current and effective in today’s competitive pharmaceutical environment.
Katie Chavanu, PharmD‡; Peter Ishak, PharmD‡
Declaration of Conflicting Interests
The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The authors received no financial support for the research, authorship, and/or publication of this article.
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